As heart failure (HF) is a progressive, debilitating condition, life-long self-care is required to achieve good outcomes. Rural residents with HF encounter more challenges with adherence to self-care than their urban counterparts because of rural–urban inequalities related to socioeconomic resources and access to health care. To date, investigators have focused on self-care in HF patients in urban settings, although factors related to self-care may be different between rural and urban residents.

The aim of this study was to explore the variables related to self-care in HF patients living in rural areas.

A total of 580 patients in the USA were included in this analysis. We included 12 variables reflecting four aspects that affect patients’ decisions to perform self-care: health literacy, psychosocial status, current symptom status, and aging status. We measured self-care using the European Heart Failure Self-Care Scale-9.

Depressive symptoms (β = 0.28, 95% confidence interval (CI): 0.16 to 0.45), lower perceived control (β = –0.15, 95% CI: –0.32 to –0.08), better symptom status (β = –0.11, 95% CI: –0.13 to –0.003), and annual income of <$20,000 (β = 0.11, 95% CI: 0.38–2.97) were negatively associated with self-care in rural residents with HF. The model with 12 variables explained 7.1% of the variance in self-care.

The variables included in the model did not sufficiently explain self-care among rural dwellers with HF. Given that all variables in the model were intrapersonal-level factors, more investigations that incorporate interpersonal factors (e.g. cultural beliefs and access to care) are needed in order to improve our understanding of self-care in HF patients living in rural areas.